Reimbursing telehealth: How Medicare, Medicaid, private payers differ

One of the main barriers hospitals and health systems face when deciding whether or not to adopt telehealth programs is concerns with reimbursement, but progress is being made to clear up confusion, according to the Center for Connected Health Policy.

"These gaps impede expansion of telehealth services within the healthcare field. Medicare, Medicaid and private payers offer varying degrees of telehealth reimbursement, with their reimbursement policies differing greatly in terms of services covered, and other requirements and restrictions," the CCHP's fact sheet on telehealth reimbursement reads. "Overall there is a lack of cohesiveness of policies both within and between public and private payers."

Here is how Medicare, Medicaid and private payers differ in telehealth reimbursement.

1. Medicare. Medicare only reimburses for live-video conferencing telehealth under specific circumstances that factor in where the patient lives — rural or nonrural — though some services will be exempt from these requirements beginning in 2019.

Store-and-forward telehealth, like those technologies that enable information capture and transmission other than live-video consults, is only permitted in Alaska and Hawaii.

Only select distant-site providers qualify to deliver care remotely, and the number of services they can provide is limited. Medicare frequently changes its list of approved telehealth services, but some include emergency department consultations, outpatient visits and nutrition therapy. For chronic disease management and other remote patient monitoring, Medicare is more lenient. It reimburses for non-face-to-face asynchronous remote monitoring of chronic illness.

Beginning in 2020, Medicare advantage plans will cover additional telehealth beyond those already covered in Medicare Part B, and some ACOs will be afforded more flexibility. ACOs will be able to expand telehealth services to include the home as an eligible originating site, so they will no longer be subject to Medicare's current geographic requirements.

2. Medicaid. States are allowed to determine their own policies for telehealth under Medicaid, as long as the service satisfies federal requirements of "efficiency, economy and quality of care."

As of October 2017, 48 states and Washington, D.C., reimburse at least some form of live-video conferencing, with many restrictions on the type of provider, service or geographic location. Store-and-forward telehealth is only reimbursed in 15 states and is often limited to dermatology. Twenty-one states reimburse for remote patient monitoring under certain circumstances.

3. Private payers. As of October 2017, 36 jurisdictions enacted or will soon enact laws related to private payer telehealth reimbursement. Some of these laws would expand coverage parity and require insurers cover telehealth services at the same cost as in-person visits if it meets the same standard of care.

Not all states require the services be charged the same, though. Some states have introduced payment parity bills that would mandate payers cover telehealth "at the same rate" as in-person services, while other states have created parity laws that are "subject to terms and conditions of the contract."